Individual
CONNIE GASTON
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
LMLP/LCP
Contact information
Practice address
934 N WATER ST, WICHITA, KS 67203-3838
(316) 660-7500
(316) 383-4590
Mailing address
635 N MAIN ST, WICHITA, KS 67203-3602
(316) 660-7600
(316) 383-7925
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
212
KS
103TC0700X
Clinical Psychologist
Primary
572
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2157275
CIGNA
KS
01
—
389911
BLUE CROSS BLUE SHIELD
KS
01
—
9432
PREFERRED HEALTH SYSTEMS
KS
01
—
PV119197
AMERICAN PSYCH SYSTEMS
KS
Enumeration date
05/28/2006
Last updated
07/08/2007
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